To Administer or Not? Vaccinations During COVID-19: Part I

In Part I of our COVID-19 Vaccination Series, we highlight some misconceptions about vaccine schedules and propose a structured framework to help pharmacists navigate vaccination-related concerns.

May Zheng

June 17, 2020

“I’m due for my 2nd Shingrix injection, but my family doctor’s clinic is closed. What do I do?”

With clinic closures and many pharmacies not offering immunization services, patients are worried that they can’t get their vaccinations. How are you handling this issue?


Impact of COVID-19 on Vaccinations

Recently, in response to the COVID-19 social distancing regulations, healthcare professionals have been advised to defer non-essential clinical services requiring face-to-face encounters. While the proliferation of virtual visits enables continuity of care, patients have reduced access to immunizations and disruptions to their vaccination schedules.

In fact, many pharmacies have suspended vaccinations due to heavy workloads, relocation of time to troubleshoot drug shortages, and lack of PPE. Specifically, patients receiving multi-dose vaccine series (eg. Shingrix, Varivax III, and Gardasil 9) have been most impacted. Given the complexities of patient risk vs. needs, how can we best support pharmacists to navigate these challenging circumstances?

To start, we’ve compiled a list of vaccine schedule misconceptions to support front-line pharmacists in handling vaccination services during COVID-19.

Vaccine Schedule Misconceptions

Here are some common misconceptions about scheduled vaccines:

1. Recommended maximum intervals must be strictly followed.

False, maximum intervals do not exist because the body has immunologic memory.

2. Dose intervals can be extended for all vaccines.

False, post-exposure prophylaxis (ex., rabies, varicella, meningococcus), cholera, and traveller’s diarrhea vaccines should not be delayed.

3. Minimum dose intervals are not important for most vaccines.

False, adhering to minimum intervals is crucial for the body to mount an adequate immune response.  

Research on immunization coverage assessments have shown that:

  • If vaccine dose is administered ≤ 4 days before the recommended due date, it can be considered valid
  • If dose is given earlier ( ≥4 days before due date), it is considered invalid as the efficacy cannot be assured

4. If maximum intervals don't exist, it's safe to miss vaccine doses.

False, a lapse in vaccination schedules prolongs the patient’s risk of acquiring the vaccine-preventable infection (VPI). There’s a lack of efficacy studies on delayed immunization schedules.

Additionally, to better support pharmacists in their clinical decision-making process, we created a COVID-19 Vaccination Framework based on the latest guidelines.

We collected evidence-based guidance documents from leading Canadian healthcare organizations to establish this framework. Additional resources can be found in the references section.

You can download this infographic and share with your colleagues.

Final Thoughts

It's crucial to establish contingency plans and management protocols, which provide clear guidance, alleviate stress, and promote resilience during times of uncertainty. Often, a proactive approach can ensure the adaptability of pharmacy services amidst the rapidly evolving COVID-19 crisis.

Updated June 8, 2020: CPhA guidelines advise:

  • Pharmacists to consider developing COVID-19 professional services screening forms, which can be documented in patients' file upon completion.
  • Pharmacists to consider wearing all PPE elements recommended for droplet/contact exposure (surgical mask, full-length, long-sleeved gown, gloves, and eye protection) in cases where vaccination should not be delayed for patients with suspected COVID-19.

How have you been handling vaccination concerns in your practice? Please share your learnings with us on LinkedIn, or email us at rui@medmehealth.com. We'd love to connect with you and continue the dialogue with our pharmacist colleagues.

Stay tuned for Part 2 of our COVID-19 Vaccination Series, where we use the framework to dive into a patient case.

References & Recommended Readings: 

  1. NACI Interim Guidance on Continuity of Immunization Programs: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/interim-guidance-immunization-programs-during-covid-19-pandemic.html
  2. Canadian Immunization Guide: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-10-timing-vaccine-administration.html
  3. OPA Guide to Providing Virtual Care to Patients: https://www.opatoday.com/professional/resources/for-pharmacists/tools-and-forms/virtual-care-services
  4. National Standards for Immunization Coverage Assessment: https://www.canada.ca/en/public-health/services/publications/healthy-living/national-standards-immunization-coverage-assessment-recommendations-canadian-immunization-registry-network.html
  5. Ontario Ministry of Health COVID-19 Screening Tool: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_screening_guidance.pdf
  6. OCP Code of Ethics: https://www.ocpinfo.com/library/council/download/CodeofEthics2015.pdf
  7. WholeHealth FAQ on COVID-19 Clinical & Professional Affairs for Pharmacy: https://wholehealthpharmacy.ca/wp-content/uploads/2020/03/COVID-19_External-Professional-Affairs-Clinical-FAQ_04.13.2020.pdf
  8. Personal Protective Equipment (PPE): Suggested Best Practices for Pharmacies During the COVID-19 Pandemic: https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/PPE-Best-Practice-Suggestions.pdf
  9. Protecting the Front Line - COVID-19 Day-to-Day Questions: https://www.pharmacists.ca/advocacy/covid-19-information-for-pharmacists/guidelines-for-protecting-the-front-line-covid-19-day-to-day-questions/#services%E2%80%8D

Graphics: Michelle Yee
Editors: Rui Su and Yifan Zhou

Disclaimer: The contents of this blog is to be used for informational purposes only and is not intended to replace clinical guidelines or the advice of a health professional. Patients should contact a health professional for appropriate advice.
© 2020 MedMe Health Ltd. All rights reserved.

WRITTEN BY:

May Zheng

May Zheng is a 4th-year PharmD student from the University of Toronto.

MedMe is a thought leader and software provider in pharmacy care

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